>Marcelle Cedars, M.D.


>Advances in Reproductive Medicine


>Infertility affects one in 10 reproductive-aged couples and modern

>medicine is making the dream of parenthood a reality for many. Research

>in this area may answer many questions about the beginning of life,

>ovarian aging and perhaps somatic aging. What questions remain and what

>will these answers mean for our society and the structure of the modern



>Dr. Marcelle Cedars, of UCSF School of Medicine, will talk about some of

>the new developments in reproductive medicine, exciting possibilities for

>the future and some of the ethical issues these research areas present.



Dr. Cedars began her talk by explaining that the fallopian tubes and uterus are a remarkable set of organs that do a lot more than just let the egg do its thing. The surface of the fallopian tubes has tiny fingers that move the egg along, and there are hormonal interchanges between the egg and the mother that develop over time. Simulating these in a test tube for Assisted Reproductive Technology is very nontrivial.

Then she explained that In Vitro Fertilization (IVF) is usually begun by stopping the pituitary gland from signaling the ovaries to ovulate, and then replacing those signals with artificial ones that cause several ovum to develop simultaneously. Those are then harvested and examined under a microscope. A healthy looking sperm is then immobilized and injected into one of them using a technique called Intracytoplasmic Sperm Injection (ICST). ICST is a state of the art technique, and developing it has made a big difference in the success rates of IVF. After the egg has developed into a blastocyst of eight cells or so, one of them it harvested for genetic testing. If it is OK, it is then implanted in a woman to develop normally.

IVF first succeeded during the late 1970s. While Jimmy Carter was still President much work was done to study the ethics and mechanics of progress on the issue in the USA. However, when Ronald Reagan replaced him, funding for the subject was cut to nothing, and since then the state of the art has developed in other countries much more than it has here. Places like Israel and Italy where birth is very important are where the state of the art is advancing rapidly. Considerable progress is also being made in Scandinavian Countries like Sweden, where they have socialized medicine. On the other hand, Germany is very restrictive on work in this area, mostly because of their collective memory of the WWII era.

There was much Q & A, and during that many points came out:

Using IVF it is possible for a child to have five parents. The genetic father, the genetic mother, the mother that brings the fetus to term, and the parents that raise the kid to an adult.

Fathers have much better luck supplying sperm while they are still young enough to provide healthy germ plasm than mothers. Many guys provide the stuff to be frozen before they have radiation or chemotherapy for cancer, and it works out for them. It is rare for mothers to have such luck.

A woman in her thirties has about a 50/50 chance of becoming pregnant from a cycle of egg harvesting and IVF. For a woman in her forties it is more like a 1 in 5 chance of becoming pregnant. However, they can improve their chances by trying for several cycles in a row.

Menopause happens when the ovaries run out of eggs. From menarche to their late 30s, woman only develop a few eggs per cycle, and only one of them is released at ovulation. In her later years more eggs per cycle are used up.

Dr. Cedars clinic only sees women up to the age of about 50 for help with their fertility. Some clinics see couples up to a combined age for the man and woman of less than 100. The oldest women to give birth are assisted by doctors in Italy.

The blastocycst of eight cells that is put into the womb is small enough that four to eight of them could fit on the tip of a needle.

Even under the best of conditions, only about one in four natural pregnancies takes. For IVF to even come close to that is remarkable.

Tian Harter